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Chapter 007. Medical Disorders during Pregnancy (Part 7)

Gastrointestinal and Liver Disease Up to 90% of pregnant women experience nausea and vomiting during the first trimester of pregnancy. Occasionally, hyperemesis gravidarum requires hospitalization to prevent dehydration, and sometimes parenteral nutrition is required. Crohn's disease may be associated with exacerbations in the second and third trimesters. Ulcerative colitis is associated with disease exacerbations in the first trimester and during the early postpartum period. Medical management of these diseases during pregnancy is identical to the management in the nonpregnant state (Chap. 289). Exacerbation of gall bladder disease is commonly observed during pregnancy. In part this may be due to pregnancy-induced alteration. | Chapter 007. Medical Disorders during Pregnancy Part 7 Gastrointestinal and Liver Disease Up to 90 of pregnant women experience nausea and vomiting during the first trimester of pregnancy. Occasionally hyperemesis gravidarum requires hospitalization to prevent dehydration and sometimes parenteral nutrition is required. Crohn s disease may be associated with exacerbations in the second and third trimesters. Ulcerative colitis is associated with disease exacerbations in the first trimester and during the early postpartum period. Medical management of these diseases during pregnancy is identical to the management in the nonpregnant state Chap. 289 . Exacerbation of gall bladder disease is commonly observed during pregnancy. In part this may be due to pregnancy-induced alteration in the metabolism of bile and fatty acids. Intrahepatic cholestasis of pregnancy is generally a third-trimester event. Profound pruritus may accompany this condition and it may be associated with increased fetal mortality. It has been suggested that placental bile salt deposition may contribute to progressive uteroplacental insufficiency. Therefore regular fetal surveillance should be undertaken once the diagnosis of intrahepatic cholestasis is made. Favorable results with ursodiol have been reported. Acute fatty liver is a rare complication of pregnancy. Frequently confused with the HELLP syndrome see Preeclampsia above and severe preeclampsia the diagnosis of acute fatty liver of pregnancy may be facilitated by imaging studies and laboratory evaluation. Acute fatty liver of pregnancy is generally characterized by markedly increased levels of bilirubin and ammonia and by hypoglycemia. Management of acute fatty liver of pregnancy is supportive recurrence in subsequent pregnancies has been reported. All pregnant women should be screened for hepatitis B. This information is important for pediatricians after delivery of the infant. All infants receive hepatitis B vaccine. Infants born to mothers